Equity is a theme throughout this year’s ASCO meeting, which is in a virtual format for the second year due to the pandemic. In 2018, when Pierce was selected as President of ASCO 2020-2021, Clifford Hudis, MD, FACP, FASCO, CEO of ASCO, said no one could foresee the role Pierce would play when leading the organization during the pandemic. At this year’s reunion, Hudis said Pierce turned out to be the right person at the right time.
“Sometimes it is said that leaders have to grow up and stand up to respond to the present moment, but that was not the case this year,” he said.
Throughout her career, Pierce has strived to address equity issues in health care in general and cancer care in particular; the pandemic has highlighted gaps in access to care and outcomes, and from the start, oncologists have braced themselves for a wave of late-stage diagnoses as patients miss screening and follow-up care, or diets must be changed due to pandemic protocols.
In his remarks, Pierce drew on his own experience, growing up in the 1960s, of how laws can change but inequalities persist. As a child, she knew about the civil rights movement. “Although I didn’t realize it at the time, I was observing the impact of isolation on health care,” she said. When she visited her father’s family in Ahoskie, North Carolina, “white residents had access to many high quality health care options,” but “black people were largely treated by a only African-American doctor ”.
“Looking back, no matter how skilled he was, he was still a treating physician for an entire community – every person, every age, every condition. And that, by definition, is limited, ”Pierce said.
“As I got older, going to college and then medical school, I realized that while the legal segregation I saw in North Carolina in the 1960s was over, inequalities in health care were over. remained firmly established in the United States and around the world. As a resident in radiation oncology, then as a physician and researcher specializing in breast cancer, I became increasingly committed to improving outcomes for all people with cancer.
Last summer, ASCO published a updated statement on cancer disparities and health equity, and last month Pierce followed up with a specific statement on reducing the gaps for black cancer patients. It passage quoted the Clinical Treatment Law, which comes into effect in January 2022. ASCO has advocated for the law, which will require Medicaid to fund the cost of patient participation in research; Pierce said the law should help increase the number of black patients participating in the trials. Right now, black patients make up about 15% of people with cancer in the United States, but only about 5% of patients enrolled in clinical trials.
Before Pierce began his speech, she hosted three speakers to discuss the topic of fairness: National Cancer Institute (NCI) Director Norman E. “Ned” Sharpless, MD; Julio Frenk, MD, PhD, MPH, president of the University of Miami and former Minister of Health of Mexico; and Rhea Boyd, MD, MPH, pediatrician, community health advocate and expert on the intersection of structural racism, inequalities and health.
NCI is looking for a diverse workforce
Sharpless said the year 2021 marks the 50th anniversary of the National Cancer Act, and although survival rates have improved and tobacco use has declined, the NCI is aware that success has not been felt. uniformly. Diversifying trials and improving results starts with a different workforce, and he said the agency was looking for information on how to recruit more black and Hispanic scientists and how to fund investigators. from more diverse backgrounds.
“We know the research workforce still does not reflect the population of the people we serve,” said Sharpless. It is important to “create a talent pool”.
A call for innovation
Frenk said that for all the weakness in public health infrastructure exposed by COVID-19, it has also inspired tremendous scientific collaboration and energy and, with the right support, could inspire a generation of public health leaders. He called for 3 “constructive proposals”, which he said “could make the world safer and better prepared for the next pandemic”.
They are: (1) a global network of “sentinel” health establishments to quickly collect and share data on emerging diseases and avoid the cover-up of epidemics, (2) a technological platform that would allow diagnostic tests, vaccines, therapies and other disease control tools to develop as quickly and collaboratively as possible, and (3) a “rapid deployment force,” which he described as teams international public health infantry, who could use the tools in the event of an epidemic.
Boyd’s message was blunt: We can’t end racism in healthcare if we don’t call it what it is. And too often journal articles find more delicate terms to avoid the ugly truth. Quoting author Ta-Nehisi Coates, Boyd said that racism in healthcare is often a visceral experience; racism inflicts violence on the body. But health inequalities among some populations are not inevitable – they exist because certain groups are denied protections and supports. Yet the words “institutionalized racism” are rarely used in the literature. Boyd cited a 2018 review of 50 high-impact journals over a 13-year period and found only 25 citations of the term in a title or abstract.
The tools of change
Pierce said health equity has “always been at the heart of ASCO” and can be achieved through the pillars of research, education and quality care. ASCO has formed a partnership with the Association of Community Cancer Centers increase community participation in trials. “In May,” she said, “we began recruiting over 40 clinical trial sites to test practical strategies designed to increase screening and participation of black and Latin patients. Strategies include a clinical trial site assessment tool and training to mitigate bias. “
ASCO News highlights that progress is being made, but a lot of work remains to be done. Abramson Cancer Center at the University of Pennsylvania announced presentation of a summary showing that a 5-year effort to diversify participation in clinical trials had doubled the participation share of black patients, from 12% to 24%. But on the other hand, Basic medicine announced that a presentation to be made on Tuesday will show that black men, who are more likely to carry the burden of prostate cancer than white men, are less likely to receive a complete genetic profile, based on an analysis of the world real over 11,000 men with prostate cancer.
“Men of African descent bear the greatest disease burden in prostate cancer, and this research indicates that differences in cancer care are not based solely on biological factors, but rather on socioeconomic factors. such as access to comprehensive genomic profiling and enrollment in clinical trials. ”Brandon Mahal, MD, Assistant Professor, Radiation Oncology and Deputy Director, Community Outreach and Engagement, Sylvester Comprehensive Cancer Center, who is a researcher at the ‘Foundation Medicine study, said in a statement.
Pierce’s approach has focused on the basics. She has launched a series of podcasts to teach oncology trainees how to talk to their patients about the “3 most important modifiable risk factors” for cancer: smoking, obesity and alcohol. During his tenure, ASCO conducted a survey which showed that patients’ attention to weight management improved during cancer treatment. She wants to learn from a successful colorectal cancer screening program in Delaware that has “virtually eliminated the disparities” and saved millions of dollars.
“History has its eyes on us,” Pierce said. “We are at a pivotal moment in the history of our society and in the social history of the world. We need to capitalize on the momentum and empower ourselves.
“In 1965, Dr. Martin Luther King Jr. declared that a man dies when he refuses to stand up for what is right. The lives of countless cancer patients around the world depend on our speaking out. We need to be bold in our commitment and actions for equitable care, ”said Pierce. “It’s our time. It is our responsibility. And I firmly believe that is the fate of ASCO.